Arthroscopic Ankle Arthrodesis vs Open Ankle Arthrodesis: A Propensity-Matched, Retrospective Database Analysis of Medical Complications and 2-Year Nonunion Rates.
BACKGROUND: Ankle arthrodesis (AA) is a common treatment for end-stage ankle arthritis, chronic instability, and degenerative deformity. Although minimally invasive arthroscopic techniques may reduce soft tissue disruption, postoperative pain, and related morbidity, open techniques may be beneficial for treatment of patients with aberrant anatomy, insufficient bone stock, or complex deformity. This study aimed to determine whether arthroscopic AA is associated with lower rates of adverse events, pseudarthrosis, and health care use compared with open AA techniques at short-term and long-term intervals. METHODS: We conducted a retrospective analysis using the TriNetX research network. Patients undergoing AA were identified using Current Procedural Terminology (CPT) codes for arthroscopic (CPT 29899, n = 879) and open (CPT 27870, n = 10 604) procedures. Two cohorts were defined and propensity score-matched on age, sex, race, body mass index, nicotine dependence, chronic kidney disease, and type 2 diabetes mellitus (n = 873 each). Outcomes were evaluated within 30 days, 90 days, and 2 years. RESULTS: The arthroscopic AA cohort experienced significantly lower rates of any adverse event, infection, and hospital admission within the 30-day and 90-day outcome windows. Arthroscopic AA was associated with fewer emergency department visits and wound dehiscence within 90 days of surgery. A diagnosed pseudarthrosis within 2 years was more common in the open arthrodesis cohort. Rates of short-term myocardial infarction, cerebral infarct, transfusion, pulmonary embolism, and hematoma did not differ. CONCLUSION: Arthroscopic AA was associated with significantly lower rates of medical complications at the short-term intervals, in addition to lower rates of nonunion within 2 years. Although observational, propensity-matched data are consistent with fewer short-term medical complications and lower 2-year nonunion after arthroscopic AA, the results should be interpreted with caution because of the inability to assess the degree of coronal or sagittal plane deformity in the included cases. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
